Population Policy at National and State Level

(A case of India and Rajasthan)

Shiv Chandra Mathur Professor and Head Preventive & Social Medicine Medical College, Kota 324 005 Rajasthan, India

Why this presentation?

India with a population of more than one billion scattered in 26 states and 8 union territories provide a unique ground for studying population programs management. There is a paradigm shift in population management from exclusive contraceptive delivery to concurrent dealing of all issues in the framework of reproductive health.The steps initiated under the influence of new philosophy at country and state level may give certain clues to many other countries, struggling for betterment of their population programs. Shiv Chandra,2001

Objectives
This presentation aims at: 1. Illustrating the definition of policy; 2. Steps involved in policy cycle; 3. Defining the population policy; 4. Imparting knowledge on common elements of population policies.
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Objectives (cont.)
5. Document the Process of Formulating Population Policy at State level in a Federal Country; 6. Review the content of National Population Policy, India 2000; 7. Review the National v/s State Population Policy.
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What is a Policy?
Set of Ideas or Plans that is used as a

basis for decision making; Attitude and actions of an organization regarding a particular issue; General Statement of understanding which guide decision making.
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What is a Policy
It is more than mere statement of

goals: How the stated goals can be achieved? Who will carry out the tasks? In what manner?
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Basis for Policy

Set of Values
Commitments Assessment of current situation Image of a desired future situation.

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Four stages of Policy Process

Problem Identification and Issue

Recognition Policy Formulation Policy Implementation Policy Evaluation

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Policies related to Health Sector

National Health Policy
Nutrition Policy Women Policy Training Policy Population Policy

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What is Population Policy?

Measures formulated by a range of social

institutions including Government which may influence the size, distribution or composition of human population (Driver,1972). A deliberate effort by a national government to influence the demographic variables like fertility, mortality and migration (Organski & Organski,1961) A set of Coordinated laws aimed at reaching some demographic goal (Biurgeois-Pichat,1974) Shiv Chandra,2001

Types of Population Policies

Explicit : Document by a national

government announcing its intention to affect the population growth and composition
Implicit : Directives not necessarily issued

to influence the population growth and composition but may have the effect of doing so.

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Elements common to Population Policies

Rationale : demographic analysis
Objectives and Goals Targets :
time bound level of fertility

Program Measures

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Process of Population Policymaking

Developing the Constituency in favor of

Population Policy Identifying the arguments favoring population policy Addressing the issues to a right place Visualizing the form a policy should take Recognizing the most advantageous time

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Observations on National Population Policy(NPP)India-2000

3

Objectives 4 New Structures 12 Strategic Themes 14 National Socio-demographic Goals (2010) 16 Promotional and Motivational Measures 150 Interventions
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National Population Policy-2000, India aims at

Short Term : fulfill unmet need for contraception,

strengthening the health infrastructure, integrating the services for Reproductive and Child Health. Medium Term :effective implementation of intersector strategies to substantially reduce the TFR by 2010. Long Term : to sustain the economic growth, social development and eco-conservation, stabilise the population by 2045. Shiv Chandra,2001

Demographic Targets of NPP2000 India (2010)

Fulfilling the Unmet Need for RCH

Free and compulsory education for children under-fourteen

Reducing the school dropout between boys and girls to 20

percent Bringing IMR < 30 Bringing MMR < 100 Increasing Immunization against VPDs to 100 percent Encouraging the increase in average age at marriage of girls Increasing Institutional Deliveries to 80 percent > delivery by trained hands to 100 percent Making contraceptive of choice available to 100 percent population Shiv Chandra,2001

Demographic Targets of NPP2000 India (2010) Cont.

Enhancing the IEC coverage for RTI/STI/AIDS to

cent percent population Integrating allopathy with ISM for betterment of RCH services Encouraging the small family norm to substantially reduce TFR Coordinating the activities of social sector development to make family welfare program public oriented Shiv Chandra,2001

Strategies for NPP-2000, India

Decentralise the Plan and Program

Implementation Convergence in services at delivery points Women Empowerment to mitigate nutrition/health problems of females Strengthening child survival Meeting the unmet need for FW Special services for slums Attending Adolescents Increasing Male Participation Shiv Chandra,2001

Structures to be created for NPP-2000,India

National Population

Commission under the chair of Prime Minister Population Commissions in each state under the chair of Chief Ministers Coordination Cell in Planning Commission at country level Creating Technology Mission at national level

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Population Program Promotional Measures

providing fertility regulating information/services
furnishing family life/sex education information improving the status of women

improving health and nutritional status

providing incentives and disincentives improving research and evaluation

carrying out specific legal reforms to influence

internal and international migration Shiv Chandra,2001

Population Policy at State level

India is a federation of 26 states and 6 union territories with

varying development status. While Kerala in south have exemplary demographic indicators, the situation in northern states is dismal. Although Population Management falls in the concurrent list of activities envisaged in the constitutional framework of India but with other issues of social development like Health, Education and Women development being in the state list of activities, state governments own the responsibilities to a large extent. Thus a new phenomena of policy formulation at state level has begun which may reintensify the efforts of Union Government. Since population growth and quantum influence the development of the country at large, union government has consistently interacted with states on this subject.

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Rajasthan-a large state of India

Rajasthan located in north-west India has a land area of 3.2

million sq km with a population of 54 million(2001). It is scattered in 200 urban agglomerations and more than 33000 inhabited villages. The State has one of the highest decadal population growth rate and one of the lowest literacy rate (particularly female literacy) in the country. Sex Ratio is 913 females per 1000 males. Its growth rate has consistently remained above the national average. It is 28.2 percent for the period between 1ast two census(1991-2001) The average age at marriage is less then 18 although a law exists to not to marry girls before they attain adulthood. The involvement of male in managing the fertility and Shiv reproductive phenomena is minimal. Chandra, The state has one of the highest infant mortality rate.

2001

Trends in Population Growth of Rajasthan

With the existing TFR
First 10 million 1898

4.4, CPR 40 %, IMR 86 Second 10 million 1961 63 years and decadal Growth Rate Third 10 million 1977 17 years of 28 %, the States population would reach Fourth 10 million 1988 11 years to 98.8 million by 2041 Fifth 10 million 1996 8 years A.D Sixth 10 million 2003 7 years States Population Policy aims to achieve TFR 2.1 by 2016 through raising Shiv Chandra,2001 CPR to >65%.

Policy Changes Proposed in the Sate of Rajasthan

From Medical to Specific

Social Engineering

Interventions:
Girl Child Education/Female Literacy; Gender Equity; Family Life Education; Legislative Measures; Enhancing Age at Marriage; Male Participation, and Strengthening IEC.

Behavioral Change Informed Choice Participation Sustainability

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Policy Interventions In States Population Policy of Rajasthan 2000

From Quantity to Integrated Services

Quality
Upgradation of Skills Static Centres for Sterilizns Improved access to services Upgradation of facilities Operations Research

for
Spacing Method Antenatal Care Deliveries Post-natal Care Immunization RTI Child Care Shiv Chandra,2001

Institutions to be created for Policy Implementation in Rajastahan-India

State Population

Council Popn Resource Centre District Level Committee Block Level Committee Village Level Committee Shiv Chandra,2001

Summary
It has been a unique event in the history of

Public Health in India that in the year 2000that the Population Policies have been released at the country and state level with the goal of stabilizing Population in a large subcontinent which currently constitutes one-sixth of worlds population. It is now for students of Health Management to see, how the proposed interventions work in the Shiv Chandra,2001 coming time.